Management of Lower Gastrointestinal Bleeding in Older Adults

Lower gastrointestinal bleeding, acute overt, occult or obscure in nature, causes significant morbidity and mortality in older adults. As the elderly population is expected to increase in the future, healthcare costs and the clinical burden of lower gastrointestinal bleeding will rise. Lower gastroi...

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Bibliographic Details
Published in:Drugs & aging 2012-09, Vol.29 (9), p.707-715
Main Author: Triadafilopoulos, George
Format: Article
Language:English
Subjects:
Aged
Anticoagulants
Biological and medical sciences
Blood pressure
Colonoscopy
Endoscopy
Geriatrics/Gerontology
Health care expenditures
Hemorrhage - diagnosis
Hemorrhage - etiology
Hemorrhage - therapy
Hospitalization
Humans
Internal Medicine
Lavage
Length of stay
Lower Gastrointestinal Tract
Medical sciences
Medicine
Medicine & Public Health
Morbidity
Mortality
Older people
Pharmacology. Drug treatments
Pharmacology/Toxicology
Pharmacotherapy
Rectum
Therapy in Practice
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Summary:Lower gastrointestinal bleeding, acute overt, occult or obscure in nature, causes significant morbidity and mortality in older adults. As the elderly population is expected to increase in the future, healthcare costs and the clinical burden of lower gastrointestinal bleeding will rise. Lower gastrointestinal bleeding, by definition, originates from a site distal to the ligament of Treitz and is usually suspected when patients present with haematochezia, or maroon stools per rectum. A thorough history is paramount in guiding the diagnostic steps and management but is frequently inadequate in elderly, poorly communicating, nursing home patients. The causes of lower gastrointestinal bleeding in older adults may be anatomic, vascular, inflammatory, neoplastic or iatrogenic. Comorbidity from cardiopulmonary disease, renal disease, diabetes or underlying cancer, all prevalent in older adults, may affect the incidence, severity, morbidity and mortality of lower gastrointestinal bleeding in the elderly. The use of multiple medications, particularly non-steroidal anti-inflammatory, antiplatelet and anticoagulant agents, needs to be always considered in elderly patients with lower gastrointestinal bleeding and anaemia. CT imaging and early colonoscopy are useful in determining the site of bleeding and allowing haemostasis. If unsuccessful, angiographic intervention and surgery need to be considered. Videocapsule endoscopy is useful in cases where the small bowel is suspected as the source, and its results guide the performance of double- or single-balloon enteroscopy. Optimal care should involve a coordinated effort among the primary physician, endoscopist, interventional radiologist and surgeon in order to improve prognosis and subsequent management and reduce morbidity, mortality, length of stay and overall healthcare costs.
ISSN:1170-229X
1179-1969
DOI:10.1007/s40266-012-0008-1